Provider Demographics
NPI:1023365178
Name:COZART, C.MICHAEL I (MAT, BA)
Entity Type:Individual
Prefix:
First Name:C.MICHAEL
Middle Name:
Last Name:COZART
Suffix:I
Gender:M
Credentials:MAT, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 N CLASSEN BLVD STE G50
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-6845
Mailing Address - Country:US
Mailing Address - Phone:405-605-2292
Mailing Address - Fax:
Practice Address - Street 1:1330 N CLASSEN BLVD STE G50
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6845
Practice Address - Country:US
Practice Address - Phone:405-605-2292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health